Step-A-Side Care Limited (Domiciliary Care) is a domiciliary care agency. It provides personal care to people living in their own houses in the community. It provides a service to younger disabled adults. At the time of our inspection visit the service was supporting two younger adults.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. In this report we refer to Step-A-Side Care Limited (Domiciliary Care) as Step-A-Side.

Not everyone using Step-A-Side receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

Why the service continues to be rated ‘Good’.

Improvements had been made to the recording of assessments of people’s capacity to consent to the care and support provided to them. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were protected from harm and abuse through the knowledge of staff and management. Robust staff recruitment procedures were followed. Staff were supported through training and meetings to maintain their skills and knowledge to support people.

People received support from caring staff who respected their privacy, dignity and the importance of maintaining their independence.

There were arrangements in place for people and their representatives to raise concerns about the service. Effective quality monitoring systems were in operation. The registered manager was approachable to people using the service and staff.

Further information is in the detailed findings below.

This inspection took place on 4 and 5 July 2016 and was announced. Step-A-Side is a domiciliary care service which provides personal care and support to people of all ages with physical needs as well as people who have learning disabilities, mental health problems and sensory impairments. The service provides care and support to people who live in their own homes. The level and amount of support people need is determined by their own personal needs. We only inspected parts of the service which supported people with the regulated activity of personal care. At the time of our inspection there were only three people receiving support with their personal care.

A registered manager was in place as required by their conditions of registration. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run.

People’s individual needs had been assessed before they started to use the service. People, their relatives and significant health care professionals had been involved in planning for their care.

People and their relatives were introduced to staff members before they assisted them with their personal care. Their support plans included information about how they preferred to be supported. People’s risks, support preferences and independence levels were recorded. However, where best interest decisions had been made there was no clear assessment of the person’s inability to make a decision for themselves.

Appropriate referrals were made to specialist services and health care professionals if people’s needs changed. Systems were in place to support people to administer their prescribed medicines if required.

People were visited by staff who had been trained and checked before they started to support people. Relationships between staff and people who use the service were friendly and warm.

People’s concerns were listened to and acted on. Where complaints had been received they were investigated and responded to in a timely manner in accordance with the provider’s complaints policy. The registered manager monitored the service and valued people’s feedback.

At the time of the inspection there were 19 children, young people and adults receiving a domiciliary care service and three people living in supported living accommodation.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

We observed staff at the supported living service working with people in a way that respected people’s rights and dignity. One person told us, “The girls are good to me”.

Staff knew about people’s risk management plans and used these to keep people safe. People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives. One person told us, “Staff have been helping me out with my moods.”

The systems in place ensured that accurate records were kept for administering medicines. This reduced the risk of harm to people.

People told us there was consistency in the staff that supported them. One relative told us, “They shadowed people – if someone new comes along they shadow. One staff came to shadow when they took (person) swimming. (Person) needs someone she knows.” This helped to ensure that people’s needs were being met and they were kept safe. Two people told us that their usual staff had been absent recently due to sickness and no cover had been provided, leaving them without support. However, people told us this did not happen very often.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People’s health and care needs were assessed with them, and they and their families were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they reflected their current needs.

People who used the service and their relatives told us that they were happy with the care they received and felt their needs were being met. One person told us, “They do what I want them to do.”

People and their relatives told us staff asked for their consent before providing care and that staff were good with communicating with them. One relative told us, “(Person) has limited understanding but (staff) communicates well with her. She reinforces what she needs with pictures and schedules.”

It was clear from our observations and from speaking with staff that they understood people’s care and support needs well and worked in line with people’s wishes.

Is the service caring?

We asked people and their relatives for their opinions about the staff that supported them. Feedback from people was consistently positive and people told us staff were “brilliant”, “good to me” and “we call Tracy (registered manager) Number 1”.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

We observed staff working in a caring and sensitive way with one person at the supported living accommodation and being led by them in the support they provided.

Is the service responsive?

On the day of the inspection we spoke to a psychologist who was employed by the provider and who was visiting one person because they were in a time of transition. Additional staffing had also been put in place on a short term basis to support the person. This meant that the service responded to changes in people’s lives and needs and worked well with other services to make sure people received care in a coherent way.

We saw that people’s care plans were reviewed regularly to ensure the care being provided was appropriate when people’s needs changed. One relative told us, “Tracy (registered manager) came the other week to update it now that (person) has changed school.”

Is the service well-led?

People using the service, their relatives and friends completed satisfaction surveys. Where shortfalls or concerns were raised these were taken on board and dealt with. One relative told us, “They’ve never given me cause to complain. I do get questionnaires. I fill them in.”

Staff told us they were clear about their roles and responsibilities. Where issues arose these were escalated and actioned appropriately. People told us they felt able to raise issues with staff and the registered manager and felt these would be addressed. One person told us, “If you want to change something, they change it. I’ve got no complaint with staff. I’ve said the odd bits to Tracy (registered manager). She goes off and talks to staff to sort problems out.”

The service had a quality assurance system in place, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. This included talking to their representatives.

People’s representatives had been involved with the assessment of each person’s needs and detailed care plans had been developed from this assessment. Staff understood how to communicate with the people they supported and knew how to meet their needs safely. One person’s relative said about staff, “They treat her like a sister”.

We saw evidence that staff received regular training, supervision and appraisal. Staff told us they felt well supported in their roles. One staff member said, “The Company is the best I’ve worked for”.

Results from the provider’s annual survey had been ‘very positive’ overall and we saw that the minor action points identified from the survey had since been addressed. One person’s representative said, “I can communicate with any of the staff. They are friendly and punctual. We’ve never had a bad word”.

Records were accurate and fit for purpose.

The service provides support to people of all ages but predominantly to older children and younger adults with complex needs. Due to their age and complex needs, the four young people receiving the regulated activity personal care at the time of the inspection, were generally represented by their parents. Hence in this report ‘people who use the service’ refers to the young person and their parents.

Parents told us that they had been as involved as much as they needed to be in planning care. One parent said that staff always followed their instructions to make sure that meals bought for their child while out with staff were suitable. They also told us, “They always send a wheelchair adapted car” which meant that they could get out and get things done while their child attended their outreach activities. Parents reported that they had no concerns about their child’s safety when they were supported by Step A Side Care staff. One said “I always know they take … needs one hundred percent into consideration”.

There were effective recruitment and selection processes in place. We spoke with four members of staff, they all told us they felt that their interview and selection process had been robust. Staff were clear that managers wanted to be told if there was a problem so that they could do something about it. No complaints had been received and concerns were always acted upon. Some shortfalls in care plans and managerial records were identified.